MEDICARE: DR. THOMAS WILDER STINSON III M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	39897	MA
2	207LA0401X	Addiction Medicine (Anesthesiology) Physician	39897	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	050031023	OTHER		RAILROAD MEDICARE-GBA PAL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	AA17224	OTHER	MA	HARVARD PILGRIM HEALTH
4	039897	OTHER	MA	TUFTS ASSOC. HEALTH PLANS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	992959	OTHER	MA	NETWORK HEALTH
7	J03510	OTHER	MA	BLUE CROSS & BLUE SHIELD

General Provider Information

NPI Number	:	1275504862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS WILDER STINSON III M.D.

Provider Business Mailing Address
First Line	:	400 W CUMMINGS PARK
Second Line	:	SUITE 1825
City	:	WOBURN
State	:	MA
Zip	:	01801-6519
Country	:	US
Telephone Number	:	781-820-9732
Fax Number	:	781-989-9396

Provider Business Practice Location Address
First Line	:	400 W CUMMINGS PARK
Second Line	:	STE 1825
City	:	WOBURN
State	:	MA
Zip	:	01801-6519
Country	:	US
Telephone Number	:	781-820-9732
Fax Number	:	781-989-9396

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	03/02/2012

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